Last Friday I was riding home from work with our wise-beyond-her-years Chicago admin/receptionist Jenny when our conversation turned to coping with loss.  This had not been an easy winter for Jenny, who had lost most of her earthly belongings in an apartment fire that left her homeless in February.  During the catastrophic event and the aftermath, Jenny remained steady and positive, giving support and compassion to our patients while maintaining an impressively professional demeanor in her work.  Everyone at the Moon was inspired.

Since I had been noodling a blog about loss around in my head, I thought it would be useful to ask Jenny about the fire and the strategies she used for recovery.  I thought it would provide a foil for the losses I could write about from personal experience (miscarriages and a stillbirth) and for the kinds of losses we encounter at the Moon.  These are largely emotional losses – hopes and dreams of pregnancy, failed cycles, miscarriages and stillbirth.  At times these losses are coupled with the loss of resources, in cases where couples have paid out of pocket for unsuccessful treatments, but they are largely emotional.   Jenny’s loss was concrete – literally valuable possessions as well as priceless mementos that were completely destroyed by a bolt from the blue.

“I kept telling myself that there is a bigger picture,” she said.  ”It was the old saying that ‘things happen for a reason’ that gave me strength.  I really focused on staying positive and looking for the good that might come.”

If you smell a cliche here, keep reading.  Jenny’s next words were profound.

“I think it’s human nature to contract when we experience loss.  We contract around the pain, we avoid situations that remind us of our loss and we try to avoid the emotions – sadness, anger and envy- that come when our life seems to be in shambles compared to those around us.  More than anything I tried to remain open.  To emotions, to help from others and even to situations that could be painful.”

As Jenny shared her experiences of loss and healing, I was instantly struck by their similarity to my own journey. When my first full term pregnancy ended in a stillbirth of a little girl at 38 weeks, I received one strong message from the universe:  STAY OPEN.   Take every condolence call, accept every offer of comfort from friends, eat every casserole that was delivered and, above all, cry every tear that I needed to cry.  For a very introverted and private person (at least before the creation of Pulling Down the Moon) this was indeed a radical strategy.  My entire being wanted to crawl in a hole and avoid contact with others and with my pain.

In Jenny’s case, this call to open was an intuition.  In my own case, I believe the message came through my yoga practice.  The simple practice of stretching that has been part of my life for so many years kept calling to me to use the same techniques that keep my body healthy to heal my mind.  If you’ve ever been a beginning yogi, you know it can be an uncomfortable business at first to stretch tight muscles.  Yet, with practice, the discomfort eventually releases and gives way to spaciousness and calm.  This holds true for emotional challenges, too.  When we choose to stay open and experience our loss we can actually release pain and suffering.  When we “close” around these painful emotions we may not ever let them go.  In fact, we will often consciously or unconsciously go to great lengths to avoid the aspects of life that trigger past trauma and in doing so greatly circumscribe the scope of our experience.

There seems to be an energetic rule in play here, and the similarity of Jenny’s and my experience drove this home.  In the face of loss, rather than constrict, we must look for ways to open.  Begin with a simple physical practice of stretching and breathing.  Find support where you can tell your story and cry tears with people who understand.  Eat the casserole.  Like George Costanza from Seinfeld, do the opposite of what feels comfortable and stretch instead of hunker.

These are not easy words of advice.  Yet, there is a promise of courage and self-discovery in them.  And if you need help getting there our classes, teachers and gifted practitioners are here to help.  Have you experienced loss?  What worked for you?

A couple years ago, Tami and I spent a wonderful week studying yoga nidra with an amazing teacher and yogi, Richard Miller.  At the retreat we spent a lot of time exploring the nature of our mind.  Richard shared this hilarious piece by Zen writer Kim Boykin, Meditation Hints from the Colorado Division of Wildlife.  Whether you’re a seasoned practitioner or mind/body beginner, this is worth a read.

Do any of the following statements apply to you?  If so, you may want to read further to learn why joining a fertility yoga class would be a good first step for you on the fertility journey. 

1. I feel completely out of control of my fertility journey.
2. All my friends are pregnant or have children so I feel very isolated from my peers.
3. I experience mood swings as a result of the hormonal medications I am taking.
4. I’m having trouble sleeping.
5. I am struggling to find a way to be healthy and active while trying to conceive.
6. I’ve been diagnosed with endometriosis or PCOS.

If you answered “yes” to any of the questions above,  joining a fertility yoga class is a great way for you to enter the world of holistic fertility treatments.   Read the reasons why below:

1.  I feel completely out of control of my fertility journey.

Studies show that stress is the number one reason that women drop out of insurance-paid medical fertility treatment.  In our yoga classes we use non-religious philosophical teachings from yoga to re-frame the fertility journey, focusing on tools to release stress and doubt, and emphasizing your innate ability to heal.  Studies have also shown that women who use a yoga-like coping mechanism of “letting go” of control have higher rates of IVF success. 

2.  All my friends are pregnant or have children so I feel very isolated from my peers.

There is something magical that happens when women come together and share their experiences.  We call this magic our “sacred sauce,” but it’s no secret.  Research consistenly shows that being part of a community improves both mental and physical health outcomes, and specifically, research has shown that women who participate in mind/body support groups have better IVF success outcomes.* Yoga has also been shown to reduce anxiety.

3.  I experience mood swings as a result of the hormonal medications I am taking.

Yoga can combat the side-effects of hormonal medication in a number of ways.  First, many women complain of bloating, discomfort and weight gain as a result of fertility meds.  The gentle stretching of a yoga routine encourages the movement of fluids out of bodily tissues into lymph vessels for excretion.  Also, yoga has been shown to increase levels of “feel good” neurochemicals that can combat stress and depression. 

4.  I’m having trouble sleeping.

Sleeplessness has many causes, including lack of physical exercise, caffeine/alcohol intake and stress.  During the day we can control our “monkey-mind” by distracting ourselves with work and activity.  At night, when the lights go out, our mind is free to play the “fertility-nightmare-theater.”  What-if’s, regrets and nightmare scenarios loom spring to life when we close our eyes.  Insufficient sleep can also raise cortisol (stress hormone) levels and has been associated with infertility.  Yoga’s gentle movement, breathing and mindfulness techniques stimulate our body’s “rest, digest and nest” (parasympathetic) hormonal response.

5.  I’m struggling to find a way to be healthy and active while trying to conceive.

When you’re trying to conceive, strenuous exercise is not recommended.  This means that many women who control their stress with high impact, high intensity exercise are left feeling stuck.  Yoga, because it involves a blend of movement, strength and balance can provide a vigorous workout that is low impact but has a high impact on fitness.  Unlike other forms of exercise which primarily promote blood flow to the large skeletal muscles, yoga promotes blood flow to the internal organs of digestion, reproduction and elimination. 

6.  I’ve been diagnosed with endometriosis or PCOS.

Both endometriosis and PCOS are associated with inflammation, a condition that can be harmful to our body tissues, our immune system, and potentially our oocytes.  Stress exacerbates inflammation and new research suggests that women who practice yoga regularly may be more resistant to the physiological impacts of stress.   Women with PCOS have also been shown to have higher levels of sympathetic tone (the hormones associated with the “fight or flight” stress response). 

Fertility yoga is also easy on the pocket book.  If you join a fertility yoga class at Pulling Down the Moon you will learn techniques that will serve you well over the course of your fertility journey and beyond.  If the class is too expensive or not geographically possible, you can always check out a book or video and begin practice on your own. 

As always, if you have any questions regarding fertility yoga, please post your comments here.  Experts are standing by!  Be present, be positive…become a fertility yogini!   

*Domar et al.  Presented at the American Society for Repro Medicine conference

More evidence in support of yoga for fertility:

A new study examining the potential stress-reduction benefits of hatha yoga practice compared the inflammatory and endocrine responses of healthy women to a restorative hatha yoga session and to control activity.  Half of the 50 subjects were “expert yoginis” (women with a regular yoga practice) and half were yoga novices.  Prior to each intervention session the women were subjected stress challenges in order to guage the extent that yoga speeds recovery from stress.  The results of the study were very interesting.

1. The yoga session boosted mood compared to the control activities, but no change was found in subjects’ response to stress before and after yoga or any of the control sessions.  HOWEVER…
2. In response to the stress events the novices, who were not statistically different in age or other variables from the expert yoginis, had C-Recative Protein levels (a marker of inflammation) that were 4.75 times as high as the experts.

The researchers concluded “the ability to minimize inflammatory responses to stressful encounters” lowers the burden that stress places on an individual.  They also suggested that their research supports the idea that regular yoga practice dampens stress-related changes and can have lasting health benefits. 

These findings are extremely relevent for women struggling with infertility.  Stress is an inflammatory condition and inflammation is implicated in many infertility diagnoses including PCOS, endometriosis, miscarriage and potentially even poor egg and sperm quality.   The take-home from this research is that yoga may do more for a woman who is trying to conceive than reduce her anxiety levels and improve her mood.  Regular yoga practice may actually improve her physiological response to stress events and protect her body from the negative effects of chronic inflammation.

Perhaps the most common question we get at the Moon is “where should I start?”  Women and couples are interested in doing everything they can to increase their odds of conceiving.  But among all the services available – nutrition counseling, acupuncture, yoga for fertility and massage – where to begin?  For the answer to this question, stay tuned to our blog this week as we discuss the different treatments we offer at Pulling Down the Moon and who will best benefit from these treatments.

The most important thing to recognize, though, is that using holistic treatment for fertility requires your participation.  Unlike a medical regimen, where you simply follow the directions your doctor provides, holistic treatment asks you to become involved in identifying and correcting physical, mental and emotional imbalances in your life.  In a sense, these treatments require you to be part of the treatment team.  This is true even if you are also using medical fertility treatments in addition to holistics.

The other point to make about holistic therapy is that it can take some time to work.  Treatments like acupuncture have shown short-term benefit (as few as two acupuncture treatments have been shown to increase IVF success rates), but studies using a longer treatment time frame actually have much more impressive results.  Nutrition changes can also be effective immediately, especially in terms of improving gut function, but other more long-term effects (potential improvement in egg or sperm quality, reduced inflammation, ovulation induction in PCOS) can take several months to achieve.   We feel great for a few hours after yoga or a massage – but longer term practice of these modalities actually leads to a lasting calm in which our body and mind can begin to heal themselves. 

So what’s right for you?  Stay tuned to our blog this week for a deeper exploration of what holistic fertility techniqes are right for you.   Also, feel free to post your questions.  We’ve got experts standing by. 

Be present, be positive!  Paige

Have you ever had a week where a single idea pops up at you from a million directions at once?   In my life this week the theme that started to emerge was transition.  It cropped up in yoga classes, in conversation with friends, even at Pulling Down the Moon as we adapt to our cool new website and e-commerce system.  Transition is also all around outside.  In Chicago the mountains of winter snow outside my door are melting – revealing the shoots of tulips already breaking through the earth.  Of course, as a yogi, I believe that the themes emerging in my outer life contain clues to  my inner life.  So when I went to my yoga mat this week, I meditated on transition. 

At Pulling Down the Moon our fertility yoga practice is a style of yoga called vinyasa,  a flowing series of postures.  As I practiced this week I turned my attention to the transition between the postures rather than the postures themselves.  What I found was fascinating.  Moving from one pose to another with awareness was much harder than moving without awareness.  Between each pose I discovered an infinite number of experiences of breath, balance, strength and mastery.

Finishing that week of practice, I had what we call a “yoga insight” (or satori, in Sanskrit).  Transition is the place where life is actually happening!  Each ”finished” pose is gone – belongs to the past – and each “future pose” is fantasy – belonging to an idealized future.  Yet in the middle, where the pose is emerging and awareness is shaping each moment, life and joy are always present.

Infertility is a transition, too.  We are moving from our previous childless existance toward parenthood.  It’s easy to reject what has come before and race toward the future.  Yet in doing so we deny our own life and existance as valid.  This week we challenge you to exist in the transition, the now, of your life.  It’s in this moment that you can feel your own strength and beauty, your own courage and the exquisite creation of life.

Women and couples who are trying to conceive often experience loss and disappointment. Pulling Down the Moon’s Dealing with Disappointment program offers patients an opportunity to come together in community and share those losses in a supportive environment.

Check out our video for more information about this program which happens quarterly.  This month, the program will be held on Thursday, March 11.

If you build it, they will come. Co-Founders Beth Heller and Tami Quinn share their story on why they decided to create Pulling Down the Moon.

What do U.S. soldiers returning from Iraq and infertility patients have in common?  They both might benefit from a form of yoga called Integrative Restoration or iRest.  A feasibility study conducted at Walter Reed Army Medical Center in Washington, D.C., indicated that a particular approach to yoga called Yoga Nidra is having a positive effect on military personnel suffering from post-traumatic stress disorder (PTSD).  Participants in the program have reported that through the use of progressive relaxation, deep breathing and meditation, symptoms of anxiety, depression, insomnia and pain have lessened. 

Meanwhile, on the infertility battlefield, PTSD takes a different yet familiar form: anxiety, depression, loss, isolation from friends, marital stress, financial burdens, spiritual crisis and feelings of being broken.  Is it possible this same technique of Yoga Nidra could help fertility patients relieve their symptoms of distress just as it has helped our soldiers? Richard Miller, PhD. Psychologist, who developed the protocol of iRest used in the Walter Reed study says, “yes.”  Dr. Miller adds, “The ultimate design of iREST/Yoga Nidra is to help people live contented lives, free of conflict, anxiety, fear and suffering.  iREST accomplishes its goal through two basic steps: (1) the embodiment of pure awareness and (2) the release of negative body sensations, emotions, beliefs and stress that give rise to self-destructive patterns.”

Embodiment of Pure Awareness

Yoga Nidra, a Sanskrit phrase which means “sleep of the yogi’s,” has been practiced by yogis and sages for thousands of years.  It is based on the idea that we have three states of consciousness: the wakeful state, dream state, and the deep dreamless sleep state.  It is thought that the dreamless sleep state is the purest form of consciousness and a connection with it ultimately leads to a greater knowledge of God or Spirit. This concept of the dreamless sleep state maybe difficult to grasp but when you are asked in the morning how you slept the night before, you usually have a deep knowledge of the answer.  You say, “I slept great” or “I tossed and turned all night.”  How do you know if you are asleep?  There is awareness within this deep, dreamless state of consciousness which the yogis contend offers the greatest opportunity for a student to experience an understanding of her innate nature.  This consciousness is pure awareness that never sleeps and welcomes every moment as it is, without analysis, judgment or conclusion.  By welcoming things as they are, a student begins to see that they are not separate, finite beings, rather infinite and eternal.  Connecting with this state of consciousness offers an opportunity to resolve mental, physical and spiritual confusion, conflict and suffering. It’s like having an internal disarmament mechanism built right into your psyche and that’s not a bad thing to have in your fertility tool belt, particularly if you find yourself among those who experience stress and self-destructive patterns while trying to conceive.

Release of Negativity

The practice of Yoga Nidra is not auto suggestion, hypnosis or a series of postures.  It is a guided process of relaxation, self-inquiry and sensory withdrawal which leads to profound contemplation and healing.  The great news is, anyone can do it.  You don’t need to have Gumby-like flexibility, a fit physique or a calm mind to practice the technique.  In fact, if you like sleeping, you will love iRest because the practice is done while lying down in a savasana style (dead man’s corpse) position.  Those who are new to the practice often fall asleep and have no conscious recollection of what might have happened during iRest.  When they wake, they feel rested and relaxed.  Interestingly, it is believed that 30 minutes of Yoga Nidra is like having three hours of regular sleep.  Take that to the sleep bank during your two-week wait! 

Yoga Nidra is a little bit of body awareness, a little bit of breathing and a whole lot of guided meditation which is meant to help the student process all of the negative emotions and situations which constantly bombard the physical world.  You can hop on the treadmill and feel a sense of stress reduction when you are finished, but just like any given point on the conveyer belt of your running machine, your problems and their associated emotions will keep popping up from time to time.  Yoga Nidra teaches us to get off the treadmill by acknowledging our stresses, emotions and problems rather than reacting to them.  In so doing, we will experience a more lasting type of healing.

Infertility and Trauma

            Yoga, military veterans and holistic fertility are three phrases one would not expect to find in the same article.  While some may find it a stretch to connect the stresses of battle with the stress of infertility, the fact is that studies have shown that women undergoing IVF have depression and anxiety rates similar to women with cancer and AIDS (Domar AD et al.  The psychological impact of infertility:  a comparison with patients with other medical conditions.  J Psychosom Obstet Gynaecol 1993;14 Suppl:45-52).  For those that haven’t experienced difficulties getting pregnant, it’s difficult to truly recognize the trauma that can occur.  At Pulling Down the Moon, we find that many women actually seek out holistic treatment following a particular trauma – a miscarriage, failed cycle or devastating piece of news.  Take Eleanor, for instance, who finally conceived after years of fertility treatment only to have her baby die in utero from a cord incident.  Or Steve, who learned after a routine sperm analysis that he has no viable sperm and no chance of fathering a biological child. Or Amy, whose gynecologist diagnosed her with early menopause at the age of 27.   Such events, while not life threatening, are deeply shocking and challenge one of our most primal drives – the drive to procreate.  In addition, they assail deeply held beliefs of marriage, partnership and family.

            Time and again in our classes we hear traumatic stories of miscarriages, phone calls from the nurses with “devastating” news, and the overpowering fear of having to try again only to experience another failure or loss.  These memories are often denied or pushed below the surface without sufficient time for grieving and/or processing because infertility is largely a private experience that occurs simultaneously with daily life, work and relationship experiences.  Unlike death in the family or major illness, there is no established societal framework for honoring and working through the losses and challenges associated with infertility.  Many former fertility patients report that routine ultrasounds, a television commercial that features a swimming sperm or even a phone call from a newly pregnant friend can evoke feelings of panic and helplessness well beyond the resolution of their fertility treatment. 

Are you Sleeping?

Since research has shown that women who are depressed or anxious have significant declines in IVF success rates (Chen TH, Chang SP, Juang KD. Human Reprod. 2004; 19:2313-2318), it is easy to see the value of a practice like Yoga Nidra which reduces stress and helps a woman feel more empowered while trying to conceive.  At Pulling Down the Moon we incorporate Yoga Nidra into our Tools for Healing Yoga Class and are offering a new class called WeRest for couples in September of 2007.  Beyond the practical value of stress reduction, our students state that one of the most profound experiences of the practice is using deep relaxation for setting a private intention or Sankalpa.  This allows them the opportunity to ask for their heart’s desire in a way in which they, themselves, suspend judgment on the nature of the intention and its outcome. The teacher then instructs them to believe that this intention has already manifested.  This puts motivation and energy behind the intention so the student feels as though they are actively working toward, and have the ability to attract those things they want in their life.  Similarly, they are getting rid of those things that are not conducive for achieving their intention. 

What we see in our classes is that women going through fertility are often “sleeping” or at war with themselves.  The series of tests, treatments and disappointing outcomes take them further away from their purest form of consciousness and throws them into a state of confusion and separation.  They are not truly “awake” to their true potential.  When they start welcoming life as it is rather than how they imagine it should be, they awaken from their own symbolic “sleep” and experience the genie in the bottle that exists in each and every one of us.  

If you are interested in practicing Yoga Nidra/iRest make sure you seek out a yoga instructor who has been specifically trained and certified to teach its methods.  As an alternative to private or group instruction, there are several CD’s which offer exceptional value in taking a student through the process such as Richard Miller’s, “Infinite Awakening: The Principles and Practice of Yoga Nidra,” and Rod Stryker’s “Relax into Greatness.”  For more information about iRest or Yoga Nidra, or to find Yoga Nidra CDs for practice, you can visit www.pullingdownthemoon.com or www.nondual.com.  We also offer iRest for Fertility workshops at our Rockville location.  Click here for details.

As part of our free patient education series sponsored by Fertility Centers of Illinois, we offer a fun class called The Relaxation Response designed for women (and partners) who are stressed, struggling with the ups and downs of fertility challenges and willing to explore meditation as a way to calm body and mind.  

To understand why meditation helps, it’s useful to understand a bit more about stress. One of our favorite holistic teachers, Deepak Chopra, defines stress as what happens when our needs are not met.  For instance, if we perceive that we need to get to work by 9 and we’re stuck in traffic at 8:55 we get stressed.  If our monthly bills are greater than the money we have to pay them with we get stressed.  If we need a baby and we’re not getting pregnant that, too, generates a tremendous amount of stress. 

To deal with stress skillfully, it’s important to recognize its rightful place in our biology.  What we call “stress” – that stomach-churning, heart pounding reaction to an irritating boss or a negative beta-HCG result- is actually a valuable evolutionary mechanism that has allowed for the survival of our species.  The biological stress response is called the “fight or flight” mechanism.  Long ago, human survival depended on the ability to fight or run from bigger, meaner predators.   The secretion of “stress hormones” like cortisol and adrenaline facilitate physiological conditions that would allow escape from a hungry saber tooth.  During the stress response, blood is shunted from internal organs to the skeletal muscles, the heart and respiratory rate increase, glucose is released from muscles and liver to fuel our muscles, platelets in the blood become “stickier” to reduce blood loss in the case of injury and non-essential activities such as digestion, physical repair and reproduction are dialed back. All fine and good when we’re talking about a tussle with a tiger but in that scenario there’s resolution –either we kill the beast, escape or get eaten.   But in this age of 24/7 communication, we can see that a sustained, unrelenting stress response can severely impact our physical wellbeing.

Any fertility patient who hears the words “just relax and you’ll get pregnant,” is apt to eye-roll or worse.  However,  increasing clinical evidence suggests that stress may impair a woman’s ability to conceive both “naturally” and with Assisted Reproductive Technology (ART). Cortisol down-regulates our reproductive system.    Women who do not ovulate have been shown to have higher levels of cortisol in their blood, and a similar correlation has been noted in IVF patients, with higher levels of cortisol associated with poor outcomes.  It also seems that cortisol effects fertility directly, as recent studies show that stress actually damages uterine receptivity (how prepared the uterus is to hold and nourish an embryo) in mice.  

So what’s the solution?  If we’re serious about improving our overall health and fertility, we must address our immediate response to stressful situations.  Here are several tips for identifying and eliminating excess stress in our lives.

• Make stress reduction a part of your fitness regimen.  Taking 20 minutes a day to practice stress reduction techniques will make a serious dent in your stress levels.
• Learn to breathe mindfully.  The breath is a key way to “stop the bleeding” in the midst of a stressful situation.   Deep, slow breathing in a stressful situation reduces the severity of the stress response.
• Practice hatha yoga.  This ancient system teaches gentle stretches, breath awareness and mindfulness techniques that release tension and dis-ease in the body.  Rather than “fight or flight,” yoga promotes the “rest, digest and nest” hormonal response. 
• Learn to meditate.  Meditation is a chance to cultivate a non-reactive mind.  Often, stressful events will “re-play” during meditation, evoking their panic messages.  As we learn to observe these repeat performances in stillness we short circuit their power.
• Live more simply.  If stress arises when our perceived needs are not being met, have an honest conversation about yourself about what it is you really need to be happy.  Try to let go of the things that aren’t so important.  Recognize that all of our modern gadgets make our needs seem more immediate than ever before and try to lessen the pressure you put on yourself to respond to work and life situations in light-speed. 
• Take time for deep relaxation.  Practices like yoga nidra (deep guided relaxation), listening to beautiful music and spending time in nature can restore our body and mind to balance.

There’s a great saying in the yoga world, “don’t just do something, sit there!”   While this advice may fly in the face of our go-go worldview, it contains deep wisdom.   Stress is a reality in our lives that we cannot run away from.   It’s hard-wired into our biology.  Thankfully, instead of razor-sharp teeth human kind was gifted with big brains and the ability to study our own behavior.   When we become aware to the negative impact of stress on our body and mind and begin to set aside time to address it, we may finally have the tiger by the tail. 

Now, the thing about relaxing is that you actually have to do it.  We suggest you join a yoga class or get into a community that shares the intention of reducing stress and increasing relaxation.  The next Relaxation Response class will be offered at our Chicago center in March (click here to sign up) and we are also offering a yoga nidra workshop at our Rockville center this Sunday, February 28 (click here for info).   We hope to see you there! 

Be present, be positive…be peaceful!  Paige